Monthly Archives: November 2007

How-To: Find the best Medicare Part D prescription drug plan

Pharmacy

So we’re in the open enrollment period for Medicare Part D. It started on November 15, and it ends on December 31. I’ve been doing consulting twice a week, and the scramble is in full effect. While I do quite a bit more than plunk in drugs and quantities for my consulting, there is one tool that is the backbone of what I do when running various scenarios. It’s the Medicare.gov plan finder.

This guide does not apply if you have a hybrid medicaid-medicare plan through your state. Those folks know who they are, and if you have no idea what I’m talking about, you don’t need to worry about it.

Before you begin you’ll need three things:

  1. A complete drug list of the person you’re doing the research for. This means you’ll need drug names, strengths, and quantities. Calculations are done for a 30-day supply, so if you take something 3 times a day, the quantity for 30 days will be 90.
  2. About five minutes
  3. An Internet connection (har har)

Here’s a walk-through, so you’ll want to open the link in a new window or tab…

Continue reading How-To: Find the best Medicare Part D prescription drug plan →

How do you handle stepping on someone else’s toes?

Pharmacy

Two recent posts of mine have dealt with bad information, and both times I’ve wondered what the accepted protocol is for addressing it. Obviously “Hey dumbass, go read some medical literature,” doesn’t cut it. I addressed one instance — the cholesterol one — quietly, after it happened. It wasn’t life-threatening misinformation, so immediate intervention didn’t seem necessary.

I didn’t bother to say anything about the antibiotic shenanigans.

The trouble with this is addressing something someone does without stepping on their toes. If I do something stupid, I’d like someone to smack me upside the head and tell me I’m wrong. Pussyfooting around the issue is for people with no self-confidence. I don’t have that problem — after all, I write on the Intarweb, and think people actually care about what I have to say, don’t I? ;) — so just come right out and tell me I’m wrong.*

Not everyone is that resilient, however, and I’m sensitive to this.

Recently I’ve heard a pharmacist say she was going to take lots of Vitamin C and echinacea to get over a cold. I’ve seen pharmacists recommend Airborne for cold on more than one occasion. I’ve heard a pharmacist recommend a homeopathic remedy for migraine. I said nothing — these suggestions aren’t harmful, but they certainly aren’t helpful, either. In these cases, it’s just not worth the effort. Besides, Father Time and the body’s own defenses will clear these problems up on their own. (And in the case of the migraine, I suspect it was psychosomatic anyway.)

When someone says something boneheaded to a patient, how do you handle it? Especially if it’s a pharmacist colleague? I would imagine doctors and nurses run into this problem from time to time as well, even if they practice alone now.

* I’m happy to say that this hasn’t happened in a very long time, which can be viewed as either a good thing (I’m SMRT!) or a bad thing (I work with a bunch of idiots). Which one I lean towards is dependent on where and who I am working with, naturally.

Bacteriostatic doesn’t mean “ineffective”

Pharmacy, ,

I hear some wacky stuff come out of the mouths of pharmacists sometimes, and it makes me sad, because they should know better. One recent gem, said to a technician was “Well Zithromax doesn’t actually kill the infection. It’s a bacteriostatic drug, so it doesn’t really do anything. Why waste your money? Amoxicillin’s the same way.”

My blood pressure went up a few points — at least they didn’t say it to a patient.

Bacteriostatic doesn’t mean that it doesn’t work. It also doesn’t mean that you’d be just as well off taking sugar pills. In fact, there are relatively few bactericidal drugs out there, and most of them are the nuclear bombs of the antibacterials: fluouroquinolones, vanco, rifampin, linezolid, and so on. The majority of oral antibiotics that are filled on a daily basis are, in fact, bacteriostatic.

And guess what? It doesn’t matter. Bacteriostatic drugs hold the infection in check while the immune system clears it out. I thought this was common knowledge; I guess I was wrong. Of course there are instances when this isn’t good enough. Those are the minority of circumstances, however. Infections don’t usually need to be killed. That’s why we have an immune system.